X-ray Induced Electric Currents in Anodized Ta2O5: Towards a Large-Area Thin-Film Sensor.

PURPOSE: We investigated the characteristics of radiation-induced current in nano-porous pellet and thin-film anodized tantalum exposed to kVp X-ray beams. We aim at developing a large area (≫cm2) thin-film radiation sensor for medical, national security and space applications. METHODS: Large area (few cm2) micro-thin Ta foils were anodized and coated with a counter electrode made of conductive polymer. In addition, several types of commercial electrolytic porous tantalum capacitors were assembled and prepared for irradiation with kVp X-rays. We measured dark current (leakage) as well as transient radiation-induced currents as a function of external voltage bias. RESULTS: Large transient currents (up to 50 nA) under X-ray irradiation (dose rate of about 3 cGy/s) were measured in Ta2O5 capacitors. Small nano-porous Ta and large-area flat Ta foil capacitors show similar current-voltage characteristic curve after accounting for different X-ray attenuation in capacitor geometry. The signal is larger for thicker capacitor oxide. A non-negligible signal for null external voltage bias is observed, which is explained by fast electron production in Ta foils. CONCLUSIONS: Anodized tantalum is a promising material for use in large-area, self-powered radiation sensors for X-ray detection and for energy harvesting.

Combined clinical and research training in medical physics in a multi-institutional setting: 13-year experience of Harvard Medical Physics Residency Program.

PURPOSE: This manuscript describes the structure, management and outcomes of a multi-institutional clinical and research medical physics residency program (Harvard Medical Physics Residency Program, or HMPRP) to provide potentially useful information to the centers considering a multi-institutional approach for their training programs. METHODS: Data from the program documents and public records was used to describe HMPRP and obtain statistics about participating faculty, enrolled residents, and graduates. Challenges associated with forming and managing a multi-institutional program and developed solutions for effective coordination between several clinical centers are described. RESULTS: HMPRP was formed in 2009 and was accredited by the Commission on Accreditation of Medical Physics Education Programs (CAMPEP) in 2011. It is a 3-year therapy program, with a dedicated year of research and the 2 years of clinical training at three academic hospitals. A CAMPEP-accredited Certificate Program is embedded in HMPRP to allow enrolled residents to complete a formal didactic training in medical physics if necessary. The clinical training covers the material required by CAMPEP. In addition, training in protons, CyberKnife, MR-linac, and at network locations is included. The clinical training and academic record of the residents is outstanding. All graduates have found employment within clinical medical physics, mostly at large academic centers and graduates had a 100% pass rate at the oral American Board of Radiology exams. On average, three manuscripts per resident are published during residency, and multiple abstracts are presented at conferences. CONCLUSIONS: A multi-institutional medical physics residency program can be successfully formed and managed. With a collaborative administrative structure, the program creates an environment for high-quality clinical training of the residents and high productivity in research. The main advantage of such program is access to a wide variety of resources. The main challenge is creating a structure for efficient management of multiple resources at different locations. This report may provide valuable information to centers considering starting a multi-institutional residency program.

Clinical application of a template-guided automated planning routine.

PURPOSE: Determine the dosimetric quality and the planning time reduction when utilizing a template-based automated planning application. METHODS: A software application integrated through the treatment planning system application programing interface, QuickPlan, was developed to facilitate automated planning using configurable templates for contouring, knowledge-based planning structure matching, field design, and algorithm settings. Validations are performed at various levels of the planning procedure and assist in the evaluation of readiness of the CT image, structure set, and plan layout for automated planning. QuickPlan is evaluated dosimetrically against 22 hippocampal-avoidance whole brain radiotherapy patients. The required times to treatment plan generation are compared for the validations set as well as 10 prospective patients whose plans have been automated by QuickPlan. RESULTS: The generations of 22 automated treatment plans are compared against a manual replanning using an identical process, resulting in dosimetric differences of minor clinical significance. The target dose to 2% volume and homogeneity index result in significantly decreased values for automated plans, whereas other dose metric evaluations are nonsignificant. The time to generate the treatment plans is reduced for all automated plans with a median difference of 9' 50″ ± 4' 33″. CONCLUSIONS: Template-based automated planning allows for reduced treatment planning time with consistent optimization structure creation, treatment field creation, plan optimization, and dose calculation with similar dosimetric quality. This process has potential expansion to numerous disease sites.

Application programming interface guided QA plan generation and analysis automation.

PURPOSE: Linear accelerator quality assurance (QA) in radiation therapy is a time consuming but fundamental part of ensuring the performance characteristics of radiation delivering machines. The goal of this work is to develop an automated and standardized QA plan generation and analysis system in the Oncology Information System (OIS) to streamline the QA process. METHODS: Automating the QA process includes two software components: the AutoQA Builder to generate daily, monthly, quarterly, and miscellaneous periodic linear accelerator QA plans within the Treatment Planning System (TPS) and the AutoQA Analysis to analyze images collected on the Electronic Portal Imaging Device (EPID) allowing for a rapid analysis of the acquired QA images. To verify the results of the automated QA analysis, results were compared to the current standard for QA assessment for the jaw junction, light-radiation coincidence, picket fence, and volumetric modulated arc therapy (VMAT) QA plans across three linacs and over a 6-month period. RESULTS: The AutoQA Builder application has been utilized clinically 322 times to create QA patients, construct phantom images, and deploy common periodic QA tests across multiple institutions, linear accelerators, and physicists. Comparing the AutoQA Analysis results with our current institutional QA standard the mean difference of the ratio of intensity values within the field-matched junction and ball-bearing position detection was 0.012 ± 0.053 (P = 0.159) and is 0.011 ± 0.224 mm (P = 0.355), respectively. Analysis of VMAT QA plans resulted in a maximum percentage difference of 0.3%. CONCLUSION: The automated creation and analysis of quality assurance plans using multiple APIs can be of immediate benefit to linear accelerator quality assurance efficiency and standardization. QA plan creation can be done without following tedious procedures through API assistance, and analysis can be performed inside of the clinical OIS in an automated fashion.

LINAC based stereotactic radiosurgery for multiple brain metastases: guidance for clinical implementation.

Introduction: Stereotactic radiosurgery (SRS) is a promising treatment option for patients with multiple brain metastases (BM). Recent technical advances have made LINAC based SRS a patient friendly technique, allowing for accurate patient positioning and a short treatment time. Since SRS is increasingly being used for patients with multiple BM, it remains essential that SRS be performed with the highest achievable quality in order to prevent unnecessary complications such as radionecrosis. The purpose of this article is to provide guidance for high-quality LINAC based SRS for patients with BM, with a focus on single isocenter non-coplanar volumetric modulated arc therapy (VMAT). Methods: The article is based on a consensus statement by the study coordinators and medical physicists of four trials which investigated whether patients with multiple BM are better palliated with SRS instead of whole brain radiotherapy (WBRT): A European trial (NCT02353000), two American trials and a Canadian CCTG lead intergroup trial (CE.7). This manuscript summarizes the quality assurance measures concerning imaging, planning and delivery. Results: To optimize the treatment, the interval between the planning-MRI (gadolinium contrast-enhanced, maximum slice thickness of 1.5 mm) and treatment should be kept as short as possible (< two weeks). The BM are contoured based on the planning-MRI, fused with the planning-CT. GTV-PTV margins are minimized or even avoided when possible. To maximize efficiency, the preferable technique is single isocenter (non-)coplanar VMAT, which delivers high doses to the target with maximal sparing of the organs at risk. The use of flattening filter free photon beams ensures a lower peripheral dose and shortens the treatment time. To bench mark SRS treatment plan quality, it is advisable to compare treatment plans between hospitals. Conclusion: This paper provides guidance for quality assurance and optimization of treatment delivery for LINAC-based radiosurgery for patients with multiple BM.

Angular dose anisotropy around gold nanoparticles exposed to X-rays.

Gold nanoparticle (GNP) radiotherapy has recently emerged as a promising modality in cancer treatment. The use of high atomic number nanoparticles can lead to enhanced radiation dose in tumors due to low-energy leakage electrons depositing in the vicinity of the GNP. A single metric, the dose enhancement ratio has been used in the literature, often in substantial disagreement, to quantify the GNP's capacity to increase local energy deposition. This 1D approach neglects known sources of dose anisotropy and assumes that one average value is representative of the dose enhancement. Whether this assumption is correct and within what accuracy limits it could be trusted, have not been studied due to computational difficulties at the nanoscale. Using a next-generation deterministic computational method, we show that significant dose anisotropy exists which may have radiobiological consequences, and can impact the treatment outcome as well as the development of treatment planning computational methods.

Toward a multi-layer micro-structured detector for high-energy electron radiotherapy.

BACKGROUND: The use of electron beams has been rekindled by the advent of ultra-high-dose rate radiotherapy (FLASH) and very high energy electrons (VHEE). The need for development of novel technology for beam monitoring and dosimetry of such beams is of paramount importance prior to their clinical translation. PURPOSE: In this work we explore the potential of a multi-layer nanoporous aerogel High-Energy-Current (HEC) detector as a dosimeter for electron beam. The detector does not suffer from radiation damage or signal saturation, making it suitable for very-high-dose-rate applications. Standard dose rates and energies are used to establish reference for FLASH and VHEE. We explore detector response to electron energy and residual range both experimentally and computationally. METHODS: Multilayer HEC detectors were constructed using 1×-10× basic modules of Aluminum(Al)_aerogel(A)_Tantalum(Ta) with 10-70 µm layer thicknesses. Signals are collected from all electrodes (3-21, depending on module multiplicity) with zero external voltage bias. Measurements are acquired as a function of depth(z) in water equivalent plastic using Varian TrueBeam for energies E = 6,9,12,15 MeV (SAD = 105 cm, 6 × 6 cone, 1000 MU/min). Computational simulations of identical detector geometries are performed using the 1D deterministic code CEPXS/ONEDANT. Additionally, percent-depth-doses PDD(z), measured with diode in water, are used to explore the response of HEC for various energies and residual ranges. RESULTS: The current measured from Ta electrodes resembles the shape of deposited charges in water and it is proportional to the derivative of the clinical PDD corrected for contribution from photon contamination. The signal is positive on the surface, and it decreases with depth reaching a negative local minimum at z = R50, before increasing again, reaching zero at about the practical range z = Rp. In contrast, the signal from Al electrodes is shaped like the electron PDD(z) shape but with lower signal at the surface and higher bremsstrahlung tail. By subtracting the signal from Ta and Al electrodes we obtained a curve resembling PDD(z,E) after Bremsstrahlung contamination correction. CONCLUSIONS: Multi-layer HEC sensors exhibit characteristic responses to electron beams that are unlike responses of ion chambers or diodes. Since the sensor structures are sensitive to electronic disequilibrium, high-Z electrodes give a signal proportional to the charge deposition pattern and can be modeled using the derivative of PDD(z).

Radioactive source localization employing resistive electrode array (REA) detector.

Objective.In this feasibility study, we explore an application of a Resistive Electrode Array (REA) for localization of a radioactive point source. The inverse problem posed by multichannel REA detection is studied from mathematical perspective and involves the questions of the minimal configuration of the conductive leads that can achieve this goal. The basic configuration consists of a circularly shaped REA with four opposite electrical lead-pairs at its perimeter.Approach.A robust mathematical reconstruction method for a 3D radioactive source relative to the REA is presented. The characteristic empirical Green's function for the detector response of the REA is determined by numerically solving Laplace equations with appropriate boundary conditions. Based on this model, Monte Carlo simulations of the inverse problem with Gaussian noise are performed and the overall accuracy of the localization is investigated.Main results.The results show a 3D error distribution of localization which is uniform in the (x,y)-plane of the REA and strongly correlated in the orthogonalz-axis. The overall accuracy decreases with higher distance of the source to the detector which is intuitive due to approximate flux dependence following the inverse square law. Further, a saturation in accuracy regarding the number of electrical leads and a linear dependence of the reconstruction error on the measurement noise level are observed.Significance.A broad range of REA detector configurations and their characteristics are investigated by this study for radioactive source localization allowing diverse practical applications with detector diameters ranging from millimeters to meters.

Selection of the most sensitive configuration of strip array detectors for x-ray beam monitoring in radiotherapy of cancer utilizing singular value decomposition.

We propose a concise mathematical framework in order to compare detector configurations efficiently for x-ray beam monitoring in radiotherapy of cancer. This framework consists of the singular value decomposition (SVD) of the system matrix and the definition of an effective information threshold based on the relative error inequality utilizing the condition number of a matrix. The goal of this paper is to present the mathematical argument as well as to demonstrate its use for modeling the best detector configuration for monitoring x-ray beams in external beam therapy. This analysis depends neither on specific measurements of a given set of x-ray beams, nor does it depend in specific reconstruction algorithms of the beam shape, and therefore represents a configuration meta-analysis. In the results section, we compare three possible detector designs, each leading to a highly underdetermined system, and are able to determine their effective information content relative to each other. Furthermore, by changing design parameters, such as the geometric detector configuration, number of detectors, detector pixel size, and the x-ray beam blur, deeper insight in this challenging inverse problem is achieved and the most sensitive monitoring scheme is determined. Graphical Abstract Illustration of the general approach for performing configuration meta-analysis.

Optimal parameters for clinical implementation of breast cancer patient setup using Varian DTS software.

Digital tomosynthesis (DTS) was evaluated as an alternative to cone-beam computed tomography (CBCT) for patient setup. DTS is preferable when there are constraints with setup time, gantry-couch clearance, and imaging dose using CBCT. This study characterizes DTS data acquisition and registration parameters for the setup of breast cancer patients using nonclinical Varian DTS software. DTS images were reconstructed from CBCT projections acquired on phantoms and patients with surgical clips in the target volume. A shift-and-add algorithm was used for DTS volume reconstructions, while automated cross-correlation matches were performed within Varian DTS software. Triangulation on two short DTS arcs separated by various angular spread was done to improve 3D registration accuracy. Software performance was evaluated on two phantoms and ten breast cancer patients using the registration result as an accuracy measure; investigated parameters included arc lengths, arc orientations, angular separation between two arcs, reconstruction slice spacing, and number of arcs. The shifts determined from DTS-to-CT registration were compared to the shifts based on CBCT-to-CT registration. The difference between these shifts was used to evaluate the software accuracy. After findings were quantified, optimal parameters for the clinical use of DTS technique were determined. It was determined that at least two arcs were necessary for accurate 3D registration for patient setup. Registration accuracy of 2 mm was achieved when the reconstruction arc length was > 5° for clips with HU ≥ 1000; larger arc length (≥ 8°) was required for very low HU clips. An optimal arc separation was found to be ≥ 20° and optimal arc length was 10°. Registration accuracy did not depend on DTS slice spacing. DTS image reconstruction took 10-30 seconds and registration took less than 20 seconds. The performance of Varian DTS software was found suitable for the accurate setup of breast cancer patients. Optimal data acquisition and registration parameters were determined.

Remote sensing array (RSA) for linac beam monitoring.

The purpose of the present work is to evaluate the feasibility of a novel real-time beam monitoring device for medical linacs which remotely senses charge carriers produced in air by the beam without intersecting and attenuating the beamline. The primary goal is to elaborate a theoretical concept of a possible detector geometry and underlying physical model that allows for determination of clinically relevant beam data in real time, namely MLC leaf positions and dose rate. The detector consists of two opposing electrode arrays arranged in two possible orientations around the beamline. Detection of charge carriers is governed by electromagnetic principles described by Shockley-Ramo theorem. Ions produced by ionization of the air column upstream of patient move laterally in an external electric field. According to the method of images, mirror charges and mirror currents are formed in the strip electrodes. Determination of MU rate and MLC positions using the measured signal requires solution of an inverse problem. In the present work we adopted a Least-Square approach and characterized detector response and sensitivity to detection of beam properties for different electrode geometries and MLC shapes. Results were dependent on MLC field shape and the leaf position within the active volume. The accuracy of determination of leaf positions were in the sub-mm range (up to 0.25-1 mm). Additionally, detector sensitivity was quantified by simulating ions/pulse delivered with a radiation transport deterministic computation in 1D in CEPXS/ONEDANT. For a 6 MV linac pulse, signal amplitude per pulse was estimated to be in the lower pA to fA range. We computationally demonstrated feasibility of the remote sensing detector capable of measuring beam parameters such as MLC leaf positions and dose range for each pulse. Future work should focus on optimizing the electrode geometry to increase sensitivity and better reconstruction algorithms to provide more accurate solutions of the inverse problem.

Resistive electrode array (REA) for radiotherapy beam monitoring and quality assurance.

We have developed a new type of detector array for monitoring of radiation beams in radiotherapy. The detector has parallel-plane architecture with multiple large-area uniform thin-film electrodes. At least one of the electrodes is resistive and has multiple signal readouts spread out along its perimeter. The integral dose deposited in the detector gives rise to multiple signals that depend on the distribution of radiation with respect to resistive electrode array (REA) geometry. The purpose of the present study was to experimentally determine basic detector response to MLC collimated x-ray fields. Two detector arrays have been characterized: circular and rectangular. The current and electrostatic potential distribution within the resistive electrode are governed by the Laplace and continuity equations with boundary conditions at the border with the readouts. Measurements for pencil beams showed that signal strength depends primarily on the distances between the location of the pencil beam and the readouts. Measurements for larger irregular MLC showed that signals as a function of time are quasi-linear with respect to MLC position and are proportional to the MLC area. Derivation of clinically relevant radiation beam parameters from REA signals, such as MLC position, MLC gap size and monitor unit per MLC segment relies on the detector response model with empirical model parameters. An approximate analytical detector response model was proposed and used to fit experiment data.

Technical Report: Development and Implementation of an Open Source Template Interpretation Class Library for Automated Treatment Planning.

PURPOSE: Widespread implementation of automated treatment planning in radiation therapy remains elusive owing to variability in clinic and physician preferences, making it difficult to ensure consistent plan parameters. We have developed an open-source class library with the aim to improve efficiency and consistency for automated treatment planning in radiation therapy. METHODS AND MATERIALS: An open-source class library has been developed that interprets clinical templates within a commercial treatment planning system into a treatment plan for automated planning. This code was leveraged for the automated planning of 39 patients and retrospectively compared with the 78 clinically approved manual plans. RESULTS: From the initial 39 patients, 74 of 78 plans were successfully generated without manual intervention. The target dose was more homogeneous for automated plans, with an average homogeneity index of 3.30 for manual plans versus 3.11 for automated plans (P = .107). The generalized equivalent uniform dose (gEUD) was decreased in the femurs and rectum for automated plans, with a mean gEUD of 3746 cGy versus 3338 cGy (P ≤ 0.001) and 5761 cGy versus 5634 cGy (P ≤ 0.001) for the femurs and rectum, respectively. Dose metrics for the bladder and rectum (V6500 cGy and V4000 cGy) showed recognizable but insignificant improvements. All automated plans delivered for quality assurance passed a gamma analysis (>95%), with an average composite pass rate of 99.3% for pelvis plans and 98.8% for prostate plans. Deliverability parameters such as total monitor units and aperture complexity indicated deliverable plans. CONCLUSIONS: Prostate cancer and pelvic node radiation therapy can be automated using volumetric modulated arc therapy planning and clinical templates based on a standardized clinical workflow. The class library developed in this study conveniently interfaced between the plan template and the treatment planning system to automatically generate high-quality plans on customizable templates.

Can Hyperpolarized Helium MRI add to radiation planning and follow-up in lung cancer?

Locally advanced non-small-cell lung cancer (NSCLC) is a common disease with a low overall survival even with aggressive treatments. Standard imaging (CT and PET/CT) provide no information about normal lung function. We therefore, sought to pilot HeMRI in patients with non-small-cell lung cancer before and after definitive radiotherapy (RT). Five patients with NSCLC receiving RT were enrolled on a prospective IRB approved study. Patients underwent CT, FDG-PET and HeMRI before and (within 10 days) following RT. All images (CT, FDG-PET and HeMRI) were co-registered. The CT and PET GTVs were contoured, as well as the ventilation defects on HeMRI caused by the tumor. Patients also underwent pulmonary function tests (PFTs). Correlations between the images and PFTs were evaluated by linear regression. CT and FDG-PET tumor volumes were highly correlated (r² = 0.91 before treatment and 0.99 following RT). There was less correlation between HeMRI and CT or PET (r² = 0.67 (CT) and 0.38 (PET)) prior to treatment and 0.27 following RT). However, HeMRI volumes correlated very well with FEV1, both prior to and following RT. (r² = 0.89 and 0.83, respectively). ³Helium MRI scanning is feasible in NSCLC before and after treatment. HeMRI provides important functional information in addition to CT and CT/PET scanning.

Routine pretreatment patient-specific IMRT QA (PS-IMRT-QA) should be discontinued and replaced with a real-time on-board beam monitoring system (BMS).

In an era of automated measurements and analysis, the time and resource intensive process of dosimetric plan verification for intensity modulated radiation therapy treatments would seem to be ripe for improvement. In this Point-Counterpoint contribution, the authors debate benefits of methods both hypothetical and established. I offer thanks to our contributors and note that they are writing in the classic style of a debate, the opinions that they argue may or may not reflect their personal views."

Self-powered multilayer radioisotope identification device.

PURPOSE: This is a computational study to develop a rugged self-powered Radioisotope Identification Device (RIID). The principle of operation relies on the High Energy Current (HEC) concept (Zygmanski and Sajo, Med Phys. 43 4-15, 2016) with measurement of fast electron currents between low-Z and high-Z thin-film electrodes separated by nanoporous aerogel films in a multilayer detector structure whose prototypes were previously investigated (Brivio, Albert, Freund, Gagne, Sajo and Zygmanski, Med Phys, 46 4233-4240, 2019), (Brivio, Albert, Gagne, Freund, Sajo and Zygmanski, J Phys D Appl Phys, 53 265303, 2020). Here, we present an optimal detector design that accounts for a wide energy range (keV-MeV) of x-ray-emitting radioisotopes that are of interest to national security and radiation therapy. MATERIALS: We studied numerous multilayer detector geometries with N = 1..24 basic detector elements composed of 3 electrodes: N x (Al-aerogel-Ta-aerogel-Al). The thicknesses of electrodes and their total number were varied depending on the incident x-ray spectra and its ability to penetrate and interact with the different layers, producing fast electrons. We used radiation transport simulations to find a balanced geometry that accounts for all energies from 10 keV to 6 MeV in a single design with relatively few detector elements (N = 24). In the balanced design, the electrodes have increasing thickness as a function of depth in the detector, ranging from 0.5 µm-Ta and 10 µm-Al at the entrance to 10 mm-Ta and 2.5 mm-Al at the exit. Aerogel thickness was fixed at 50 µm. Electron currents forming RIID signals were acquired from all Ta electrodes. A model function M(x, Ei ) representing the detector yield as a function of the cumulative Ta thickness (x) for 70 monoenergetic incident beams (E) was derived. We also investigated the detector response to selected radioactive isotopes (Pd-103, I-125, Pu-239, U-235, Ir-192, Cs-137, Co-60). Additional studies were performed with Bremsstrahlung spectra produced by electron beams in kVp tubes and in MV Linacs used in radiology and radiation therapy departments. We investigated different algorithms for radioisotope identification that would work for unknown unshielded as well as shielded sources. RESULTS: Characteristic features of response functions for monoenergetic beams and radioisotopes were determined and used to develop two inverse algorithms of radioisotope identification. Using these algorithms, we were able to identify the unshielded and shielded sources, quantify the minimum, mean and maximum effective energies of the shielded spectra, and estimate the amount of Compton background in the spectrum. CONCLUSIONS: A multilayer sensor based on fast electron current was optimized and studied in its abilities as RIID. A balanced design permits the identification of radioisotopes with of a wide range of keV-MeV energies. The device is low cost, rugged, self-powered and can withstand very high dose rates, allowing deployment in difficult conditions, including radiation incidents. The algorithm we developed for radioisotope identification and spectral unfolding is robust and it is an important component in practical applications.

Evaluation of MatriXX for IMRT and VMAT dose verifications in peripheral dose regions.

PURPOSE: MatriXX is a two-dimensional ion chamber array designed for IMRT/VMAT (RapidArc, IMAT, etc.) dose verifications. Its dosimetric properties have been characterized for megavoltage beams in a number of studies; however, to the best of the authors' knowledge, there is still a lack of an investigation into its performance in the peripheral or low dose regions. In this work, the authors have carried out a systematic study on this issue. METHODS: The authors compare the performance of MatriXX with a cylindrical ion chamber in solid water phantoms in the peripheral dose regions. The comparisons are performed for a number of typical irradiation conditions that involve different gantry and/or MLC motions, field sizes, and distances to the target including static gantry/open fields, static gantry/sweeping MLC gap (mimicking an IMRT delivery), dynamic gantry/oscillating sweeping MLC gap (mimicking a VMAT delivery), as well as clinical IMRT and VMAT plans. RESULTS: MatriXX, when used according to the manufacturer's recommendations, is found to disagree with an ion chamber in peripheral dose regions. This disagreement has been attributed to four types of MatriXX errors, namely, positive bias, over-response to scattered doses, round-off error, and angular dependence, all of which contribute to dose inaccuracies in the peripheral regions. The positive bias, which is independent of the dose level, is cumulative when MatriXX operates in the movie mode. The accumulation is proportional to the number of movie frames (snaps) when the sampling time is greater than 500 ms and is proportional to the overall movie time for a sampling time shorter than 500 ms. This behavior suggests multiple sources of the bias. MatriXX is also found to over-respond to peripheral doses by about 2.0% for the regions investigated in this work (3-15 cm from the field edge), where phantom scatter and collimator scatter dominate. Round-off error is determined to be due to insufficient precision in conversion of the raw signals to MatriXX software data for low doses. Angular dependence is defined as the dose response of MatriXX at different gantry angles. Up to 8% difference in detector response has been observed between 0 degree and 180 degrees. Possible sources of these errors are discussed and a correction method is suggested. With corrections, MatriXX shows good agreement with the ion chamber in all cases involving different gantry and/or MLC dynamics, as well as the clinical plans. For both primary and peripheral doses, MatriXX shows dose linearity down to 2 cGy with an accuracy of within 1% of the local dose. CONCLUSIONS: The performance of MatriXX has been systematically evaluated in the peripheral dose regions. Major sources of error associated with MatriXX are identified and a correction method is suggested. This method has been successfully tested using both experimental and clinical plans. In all cases, good agreements between MatriXX and an ion chamber are achieved after corrections. The authors conclude that with proper corrections, MatriXX can be reliably used for peripheral dose measurements within the ranges studied.

Clinical application of varian OBI CBCT system and dose reduction techniques in breast cancer patients setup.

PURPOSE: To characterize the standard modes of Varian on board imaging (OBI) v1.4 system and identify techniques to further optimize imaging parameters, in particular, for breast treatment setup. METHODS: A male anthropomorphic torso phantom was used for image quality assessment and a simpler thorax phantom for dose measurements. Both phantoms had artificial breasts attached. Doses were measured with an ion chamber in seven locations in the thorax and the breast. Evaluation of image quality was performed in terms of contrast-to-noise ratio (CNR) and in combination with the dose-to-contrast-to-noise (CNRD) parameter. The effect of kVp and mAs on the image quality, dose, and CNRD parameter was analyzed. In addition, image geometry with noncentral isocenter location with start and stop imaging angles adjusted for greater sparing of the contralateral breast was evaluated in terms of image quality and dose. RESULTS: The measurements showed doses between 0.02 and 1.6 cGy for the three full-fan modes and 0.6-3.2 cGy for half-fan modes. This is a reduction of over 80% and 30%-50% compared to OBI v.1.3 modes for full-fan and half-fan modes, respectively. The CNRD is the highest for both low dose modes (low dose thorax and low dose head). Optimal ranges for an averaged sized thorax are tube voltages not higher than 100 kVp and current-time products between 100 and 400 mAs. For the contralateral breast and lung, a dose less than 0.03 cGy per scan was measured for the optimized image geometry with the noncentral isocenter location. CONCLUSIONS: The OBI v1.4 system allows for imaging with a larger variety of imaging parameters compared to previous OBI v1.3 systems. The largest doses (up to 4 cGy) were measured in a phantom when OBI v1.4 system was used for imaging with half-fan modes. Using full-fan modes resulted in the doses less than 1.6 cGy. Further decrease in dose may be achieved by reducing mAs while preserving acceptable image quality. Organ specific sparing (e.g., contralateral breast) may be achieved by proper selection of the start and stop angles. For thorax imaging, the use of Low Dose Thorax mode is recommended.

Angular dose dependence of Matrixx TM and its calibration.

One of the applications of MatriXX (IBA Dosimetry) is experimental verification of dose for IMRT, VMAT, and tomotherapy. For cumulative plan verification, dose is delivered for all the treatment gantry angles to a stationary detector. Experimental calibration of MatriXX detector recommended by the manufacturer involves only AP calibration fields and does not address angular dependency of MatriXX. Angular dependency may introduce dose bias in cumulative plan verification if not corrected. For this reason, we characterized angular dependency of MatriXX and developed a method for its calibration. We found relatively large discrepancies in responses to posterior vs. anterior fields for four MatriXX (Evolution series) detectors (up to 11%), and relatively large variability of responses as a function of gantry angle in the gantry angle ranges of 91 degrees-110 degrees and 269 degrees-260 degrees. With our calibration method, the bias due to angular dependency is effectively removed in experimental verification of IMRT and VMAT plans.

Optimizing an analytical dose calculation algorithm for fast 2D calculations.

Previously, an analytical dose calculation algorithm for MLC-based radiotherapy was developed and commissioned, which includes a detailed model of various MLC effects as a unique feature [1]. The algorithm was originally developed as an independent verification of the treatment planning system's dose calculation and it explicitly modeled spatial and depth dependent MLC effects such as interleaf transmission, the tongue-and-groove effect, rounded leaf ends, MLC scatter, beam hardening, and divergence of the beam, which in turn resulted in a gradual MLC transmission fall-off with increasing off-axis distance. Originally the algorithm was implemented in Mathematica (Wolfram). To speed up the calculation time and to be able to calculate high resolution 2D dose distributions within a reasonable time frame (<2 s) the algorithm needs to be optimized and to be embedded in a user friendly environment. To achieve this goal, the dose calculation model is implemented in VisualBasic 6.0, which decreases the calculation time moderately. More importantly, the numerical algorithm for dose calculation is changed at two levels: the dose contributions are split into their x- and y-contributions and the calculation is aperture- rather than as originally point-based. Implementing these three major changes, the calculation time is reduced considerably without loosing accuracy. The time for a typical IMRT field with about 2500 calculation points decreased from 2387 seconds to 0.624 seconds (a factor of about 3800). The mean agreement of the optimized and the not optimized calculation algorithm at the isocenter for a fairly complex IMRT plan with 23 fields is better than 1% relative to the local dose at the measuring point.